Psychosomatic Disorders

Psychosomatic disorders are conditions in which mental and emotional factors affect physical health: psychological factors such as stress, anxiety and depression appear together with bodily symptoms. They can be defined as physical symptoms that trouble the person without an adequate medical explanation; in other words, situations in which the burden of psychological stress disrupts physiological functioning.

What does “psychosomatic illness” mean?

The word “psychosomatic” comes from psyche (mind, soul) and soma (body), and it refers to the relationship between psychological state and the body. At the root of psychosomatic illness lie psychological or emotional stressors that can lead to physical symptoms or illness.

A very wide range of symptoms can be seen. In a sense, any bodily or physiological symptom may have a psychosomatic component: pain (such as fibromyalgia), itching, numbness, loss of muscle strength, hair loss, skin problems and more. In some advanced cases, chronic and complex illnesses can also fall within this group. Because the topic concerns many branches of medicine (neurology, internal medicine, paediatrics, surgery and others), it has become a focus of research not only in psychiatry but in almost every field of medicine (PubMed).

There are no fixed criteria for diagnosing psychosomatic disorders. Diagnosis usually relies on medical and psychiatric assessment together with the specialist’s clinical experience, examining how the symptoms relate to physical health and what psychological factors lie beneath them. Specialists consider medical test results, the duration and severity of symptoms, psychosocial stressors and emotional and mental state. For example, if a patient has recurring stomach pain and medical tests find no physical cause, the specialist will explore stress, anxiety or emotional factors as a possible cause. Before a diagnosis is made, it is important to rule out other medical or psychiatric conditions.

Who is more likely to develop psychosomatic disorders?

They can occur at any age and in any gender, but some people are more susceptible:

• Emotional sensitivity: emotionally sensitive people may find it harder to cope with stress, which can lead to physical symptoms.
• Intense stress: ongoing pressure, such as work stress, family problems or serious trauma, increases the likelihood of psychosomatic symptoms.
• Mental health problems: people with anxiety disorders, depression or other mental health problems are more likely to experience psychosomatic symptoms.
• Personality traits: traits such as perfectionism, excessive worry and introversion increase susceptibility.
• Difficulty expressing feelings: people who find it hard to voice emotional needs or share emotional experiences are more prone to expressing stress through bodily symptoms.

Every person is different, and personal experiences, genetic factors and environmental influences play different roles in each individual.

Psychological pain and pain control

The main feature of psychological pain is severe, long-lasting pain. Pain is normally a sign of tissue damage. In psychological pain there is no tissue damage, or any damage present is too slight to explain the severity of the pain; the pain is felt more strongly than would be expected for that illness or injury, and no organic cause can explain it.

People with this condition also have a lower pain threshold, so stimuli that cause little pain in others are felt more strongly, which can be misunderstood as exaggeration. They often try to relieve pain by taking several painkillers in large amounts, whether needed or not. Because the pain is psychological in origin and increases with stressful events, ordinary painkillers cannot make it go away, though they may reduce it a little. This often leads to frequent changes of doctor and treatment, and the pain tends to become persistent and chronic.

Signs of psychological pain

• Thoughts are largely focused on the symptom.
• Conversation keeps returning to the pain. All problems and loss of function are explained by the pain, and it may be used as a reason to avoid responsibilities (secondary gain), often expressed as “if it weren’t for my pain, I would do this”.
• The person keeps consulting different doctors because of the pain.
• Even when there are physical findings, they are not enough to explain the pain.
• Sensitivity to pain is increased.
• The person reacts strongly when told the cause may be psychological, with angry responses such as “Are you saying I’m lying? I’m telling you the pain I feel. I’m not making it up. I’m not going from doctor to doctor for fun.”
• Painkillers are often taken in large amounts, whether needed or not.
• Recovery is possible with treatment or spontaneously, but other conditions can make the pain worse, and it often becomes chronic.

The aim of psychotherapy is to understand how the pain arises and to “translate” these bodily expressions. In this sense, pain is the way something that cannot find verbal or non-verbal expression in the person’s psychic apparatus appears in the body. Pain or any other somatisation needs to be understood in depth.

How are psychosomatic disorders treated?

Early and accurate diagnosis is very important. Focusing only on physical factors can mislead treatment and prevent results. The patient’s complaints must be listened to carefully and examined in detail. If anxiety, obsessive-compulsive disorder or depression is found, treatment is adapted accordingly.

Psychotherapy is usually the main approach. It helps the patient understand their thought patterns, emotional reactions and behaviours. While exploring the patient’s inner world, the therapist tries to identify triggers such as stress, trauma or emotional problems, builds a relationship of trust and develops strategies to ease the emotional burden. Sessions are held regularly; the therapist monitors the patient’s emotional and mental state, assesses whether symptoms are decreasing and updates the plan when necessary. Communication and cooperation between patient and therapist are essential, and the patient’s active participation and willingness to take responsibility for their own recovery matter a great deal.

Medication may be recommended in addition to psychotherapy in some cases, especially for patients with marked depression or anxiety, to help bring symptoms under control. It is not always necessary; the plan is tailored to individual needs.

Lifestyle changes also help: healthy eating, regular sleep, exercise and stress management techniques support the balance between body and mind and speed recovery. Because treatment requires a multidisciplinary approach, long-term planning and regular follow-up help patients regain their health.

Therapies used

Cognitive behavioural therapies: relaxation and imagery techniques, cognitive restructuring.

Psychoanalytic group therapy (group analysis): carried out within a psychoanalytic frame (time, place) with 4–10 members and a conductor, usually in weekly sessions of an hour and a half. The group is open to new members and allows members to leave when they have reached their goals or a satisfying point in their personal process. The length of therapy depends on individual needs (on average 9 months to 3 years).